Defining a Good Death in the Intensive Care Unit: A Systematic Review

Understanding the definition of a good death in the intensive care unit (ICU) is crucial for the effective implementation of end-of-life care. Existing reviews often focus on terminal patients and overlook the ICU setting. This study aimed to investigate the definitions of a good death in the ICU. The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and was registered with PROSPERO. The database searched included PubMed, ScienceDirect and EBSCOhost. Inclusion criteria encompassed English-language quantitative or qualitative studies published from inception until August 30, 2024, that reported definitions of a good death in the ICU and were available in full text. Exclusion criteria included studies that focused exclusively on euthanasia. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for quantitative or qualitative studies, and a narrative synthesis was performed. Definitions were categorised into themes and subthemes, with the frequency of each theme determined from the perspectives of patients, family members and healthcare professionals (HCPs). Thirty-five high-quality studies were included, with 60% of the articles representing family members perspectives. We identified five themes of a good death: Being free from suffering, withdrawing and withholdinglife-sustaining technologies in ICU settings, privacy, family involvement, and receiving spiritual and cultural support. However, discrepancies among the respondent groups were noted in the core themes: Family members emphasised being free from suffering, while patients reported family involvement more frequently. HCPs highlighted the importance of spiritual and cultural support. This review highlights the definitions of a good death in the ICU. These findings can aid HCPs in gaining a better understanding of a good death in the ICU. Future research should focus on determining the factors influencing a good death.